General medical and birthing experiences of new mothers in the Capital Health Region: an empirical and socio-historical investigation into the concept of personal agency




Coughlan, Rory

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The concept of personal agency in clinician-patient interactions is problematized by the development of societally legitimated power differentials in medical practices. The abrogation of patient perceptions of agency is also connected to interventions that tend to reproduce the separation of persons from their biological/physiological systems in reductionist, technical medical practices. Such practices continue because of their development within and harmonization to, dualistic western meta-categorizational philosophical principles. Mainstream psychological and social-psychological epistemology and methodology are deeply implicated in the undermining of the creation of a coherent, socially contextualized understanding of agency because of an adherence to Cartesian dualism. The empirical investigation consisted of the thematic qualitative analysis of 40 semi-structured, in-depth interviews with new mothers in the Capital Health region who gave birth between 1997 and 1999. Information was gathered concerning their experiences with medical personnel and institutions in general as well as focusing on their prenatal, birthing and postnatal care under 4 different clinical settings. Mothers received health services either from male or female physicians paid by traditional fee for service, by salaried physicians of either gender or from registered midwives. The results demonstrated the critical importance of patient agency in clinical relationships with regard to satisfaction and health information-seeking behaviour. The more involved and democratic model of care offered by midwives was reported as being highly satisfactory because the relationship fostered patients' agency and informational needs. New mothers reported their physician to be only marginally supportive or often unsupportive of their needs for health information and agency. The investigation also highlighted many problematic aspects of patient care at Victoria General Hospital, especially in the ante-natal ward. Many mothers experienced insufficient care and attention by hospital staff and physicians. Many staff were reported as being poorly trained in breast feeding techniques leaving many new first-time mothers feeling confused, anxious and angry. Labouring mothers who chose midwives reported overwhelmingly more satisfaction with their care at the hospital as compared to patients of physicians. Needs for personal agency are fostered when midwifes work as intermediaries between patients and hospital routines that were often found to be counter-productive to the care of labouring and new mothers. Theoretical implications were discussed. The results demonstrated a model of personal agency contextualized by both communicative and societal relationships. A combination of the models of Vygotsky and Holzkamp helped to explain patient experiences interacting with medical personnel and institutions. The findings also discuss at length some implications for health policy in the care of expecting and new mothers. Structural impediments need to be addressed in order to support rather than constrain the patient needs in becoming more fully informed regarding self and infant care.



Maternal health services, British Columbia, Victoria, Midwives